| NPI | 1346297835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 6325) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401-008132) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 32607) | |
| 1223P0700X Dentist, Prosthodontics (Licence: PA 21905) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NJ 12648) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2007-07-08 |